The Use of HFOV in Premature Infants

Use of technology in healthcare service delivery has been noted as one of the critical drivers of effectiveness in the sector, as technology creates a basis from which to ensure that the quality of health services offered matches the expectations from individual patients. Various techniques have been developed and continually improved on a day to day basis to assist in the medical procedures carried out to cure, eradicate or treat an ailment. Technological advancements have been seen as an opportunity through which nursing care can thrive and succeed in many if not all the complications that are brought forth in the fight against bodily malfunctions. One notable area of health care that has benefitted significantly from the increased use of technology in the healthcare sector is pregnancy and childbirth.

Since the 19 th century, the healthcare sector has undergone notable changes as a way of ensuring that pregnant women are facilitated with positive avenues from which to achieve the best during the process of childbirth. De Jaeger, Deurloo, van Rijn, Offringa, & van Kaam (2016) take note of the fact that healthcare professionals have been on the forefront in trying to minimize adverse outcomes associated with childbirth while reflecting on promoting safety for both mothers and their children. In many cases, where the child was premature, there was little known on how to ensure the child can get the necessary health care they require to grow to full term and survive. As a result, many babies who were born prematurely did not survive. There were too many complications associated with the birth. There was little knowledge of bacteria, protozoans and other viruses that could affect the health and survival of the baby.

During this particular period, one of the critical challenges that health professionals encountered as part of their approach towards promoting safety for mothers and their children is providing premature children with that safe environment to encourage development. In most cases, it was the doctor’s themselves who were responsible for the spread and contamination of other persons under their care (Calvert, 2002). Premature babies are often still developing most of their internal organs. Thus, this acts as a clear indication of the need for healthcare facilities to focus much of their attention towards creating environments that would not only help towards building on overall development for the children but also eliminate any forms of discomfort. The expected outcome is that this will assist in ensuring that the children respond positively as part of the treatment process.

Another critical aspect to note during this period was the fact that it was accepted that many of the babies who were born prematurely were unable to survive for long as there was little known on what to do regarding their situation (Lemos & Gomes, 2017). Calvert (2002) points out that the occurrence of industrialization has been of great value in the healthcare sector, as it has helped in facilitating health facilities with the necessary equipment that they would need in handling emergencies, thus, increasing the possibility of survival for premature children. The key challenge faced during this period was lack of knowledge on the role of technology towards ensuring that health professionals protect the lives of the early childhood. The outcome of this is that the number of lives lost due to premature births was significant, a majority of health facilities did not have the technical knowledge and capacities allowing them to work towards providing these children with a safe environment for development.

In the 20 th and 21 st centuries, the overall levels of technological development touching on the area of premature births has been significant as a way of promoting that positive avenue for effectiveness. Technology has continually innovated the kind of devices that are used in handling and managing babies that are born prematurely. Nurses and doctors are tasked with the responsibility of ensuring that these babies can access the best of care that can be awarded to them with the available medical technology and medication. As the years gradually progress, there has been a significant change in the mortality rate of babies born prematurely. The idea of using technology has helped in reducing risks for the children born prematurely, thus, ensuring that the children are accorded that safe platform for growth and development.

The complexity associated with dealing with premature children can be seen from the fact that majority of these children must be handled with absolute care during the process in which they receive health care services. De Jaegere, Deurloo et al. (2016) indicate the importance of handling these children with absolute care can be seen from the fact that the children have not achieved the expected levels of development. In other words, they may seem healthy and well developed on the outside. However, there are still other internal developments that are required to be completed so that the baby can develop properly. In many occasions, the baby is still unable to breathe by themselves as their lungs may have not fully developed, their muscle coordination may still be lacking, and their sight and hearing may still be too sensitive to adequately distinguish stimuli and other factors in their surroundings (Lu et al., 2013).

In most case, their immune system to pathogens and other disease-causing bacteria and virus may still be underdeveloped hence there is a need to ensure that their environment is purified and protected against all these factors. Consequently, this seems to suggest that exposure of these premature children to any forms of contaminated environments may have severe implications for their health status due to their underdevelopment. In the early days, due to the little knowledge regarding these factors, there was little that could be done to protect the child from these factors. Currently, technology has enhanced the Assisted Reproductive Technologies (ART) that are present within the medical industry. There are improvements in the sought of ART that is present and has subsequently raised the number of children who survive these early stages (Lu et al., 2013).

Statement of the Problem 

The use of the ventilator is considered one of the essential approaches that allow health professionals in their bid for providing premature babies with a platform from which to achieve their expected developmental goals. Calvert (2002) notes that premature babies tend to experience a significant challenge in their bid to support their breathing process attributed to the underdevelopment status of their lungs. Thus, this means that the children must be placed within mechanical equipment that would help towards supporting their breathing process in a much more effective manner. The ventilators are used for this purpose, and they assist in providing good air to the babies (oxygen) and taking out that which has been exhaled (carbon dioxide). A ventilator is a bedside machine which is attached to the breathing tube, the breathing tube is typically placed in the windpipe (trachea) of the baby, and it is adjusted as required. However, there have been various challenges that have been reported with the use of this technology.

In a study on premature babies, Van Reempts, Borstlap, Laroche, & Van der Auwera (2003) note that indeed usage of the ventilator, although may project notable effectiveness towards supporting breathing for these children, may result in unusual complications and lung problems. These problems include immature and diseased lungs that are continually at risk of injury. Van Reempts et al. (2003) indicate that the number of children with notable damages to their air sacks attributed to the use of the ventilator is significantly high, which results from the delivery of oxygen under high pressure. The distribution of air under pressure and damage the lungs can make it very difficult for the baby to breathe and thus beat the purpose of its use in supporting breathing.

Similarly, the damage to air sacks in the lungs can ultimately lead to the development of air leaks. Air leaks occur when air gets into the space that is between the lung and inner chest walls (Miedema, de Jongh, Frerichs, van Veenendaal, & van Kaam, 2012). The most common types of air leaks that have been observed in premature babies are pneumothorax leaks. A minor air leak that is found is pulmonary interstitial emphysema, where there are tiny pockets of air that are located in the lung tissue around the air sacs. The ventilators may also lead to the development of long-term damage to the lungs which can ultimately lead to bronchopulmonary dysplasia (BPD) (Miedema et al., 2012).

Purpose of Study 

The purpose of this study is to identify the advantages of using High-Frequency Oscillator Ventilator (HFOV) when compared to the usage of Conventional Mechanical Ventilators (CMV), as well as, report those advantages as proven by other scholars and publications in the medical industry. The study seeks to expound on the health care risks arising due to the usage of the CMV with the focus being towards determining whether usage of HFOV is of more value for the premature children. Additionally, the study seeks to define the overall possibility of using HFOV with the focus being towards minimizing any form of health risks for the children taking into account that this is part of establishing its advantage or benefits when compared to the conventional approach.

With the dangers that are posed due to the use of conventional mechanical ventilators when caring for premature babies, there is a need to utilize technology that can meet the needs targeted and prevent damage to the baby's lungs. Air leak syndrome has been recorded in premature infants with the numbers rising as high as 40% where the premature babies were placed under mechanical ventilators to be assisted in respiratory breathing (Jeng, Lee, Tsao, & Soong, 2012). For this purpose, the High-Frequency Oscillatory Ventilation (HFOV) is a technology that has been developed under the advancements in medical technology as a way of building on the effectiveness in a meeting set halt care outcomes. The ultimate focus will be on ensuring that the equipment helps towards improving the quality of life for the premature children.

Usage of HFOV is credited with meeting these requirements while protecting the baby from the dangers of conventional mechanical ventilators (CMV). HFOV has been used in replacement of CMV where the patients exhibit chronic respiratory diseases. Medical scholars have continued to argue that the use of HFOV provides better results compared to conventional ventilators that expose the babies to lung complications and possibly other disorders due to their use. HFOV has been purported to solve the disadvantages of CMV providing better advantages for its use.

Research Questions 

The following questions guide this project towards ensuring that it meets its expected objectives, as well as, achieving the expected implications:

What is the functionality of HFOV that triumphs over CMV in premature infants?

What are the benefits of using HFOV over CMV in premature infants?

What are the scientific breakthroughs made with HFOV in neonatal care?

Have scientists concluded on the reliability of HFOV over other ventilators in neonatal care?

Literature Review 

According to Duval, Markhorst, & van Vught (2009), mechanical ventilation is a technology that has come a long way. The earliest record of the technology was in 175 AD from Galen. Galen used a bellows to inflate the lungs of a deceased animal. The mechanisms used the concept of diffusion to function. However, this cannot be thoroughly described as a proper gas exchange as their needs to be the flow of air both in and out of the lungs. The Iron Lung was the second invention that succeeded Galen’s invention. It was done during the polio pandemic. The iron Lung used two concepts; pressure gradients and Boyle’s Law. Pressure Gradients state that gases move from areas of high pressure to areas of lower pressure until a perfect balance or equilibrium is achieved. Boyle’s Law, on the other hand, states that given equal temperature and volume, the pressure is inversely proportional to the volume of the container (Duval et al., 2009).

Van Veenendaal, Miedema, de Jongh, van der Lee, Frerichs, & van Kaam (2009) reflect on the normal breathing process indicating that the ordinary process allows for the contraction and expansion of the diaphragm when inhaling and exhaling, which plays a critical role towards reducing the pressure of the ambient air, thus, allowing for air movement into the lungs when inhaling. On the other hand, the process of exhaling results from the relaxation of the diaphragm, which, turn, results in the contraction of the chest to allow for movement of the air out of the lungs (van Veenendaal et al., 2009). The description of the inhaling and exhaling processes reflects more on the fact that the lungs play a critical role towards supporting the general expectations touching on ensuring that the body has access to quality oxygen for standard functionality.

Barr (2010) explained the functionalities of the Iron Lung. It utilized a different mechanism other than that of breathing in and out. John Emerson invented the Iron Lung or the Tank Respirator and used negative pressure to foster the action of breathing. The negative pressure did not involve the drop and rise in pressure in the chest, but the space around the chest. The Tank Respirator was a device where a person would lay on a bed inside the tank respirator (Barr, 2010). The bed had the capability of sliding in and out of the cylinder as needed and had portal windows allowing attendants to reach and adjust the various limps, sheets or hot packs. The machine was powered by an electric motor with two vacuum cleaners (Barr, 2010). The pump changed the pressure inside a rectangular, airtight metal box, pulling air in and out of the lungs (Barr, 2010). The invention was a modification of the Drinker Respirator that had been invented by Dr. Philip Drinker in 1929 (Barr, 2010).

Calvert (2002) criticizes uses of the Iron Lung to help in supporting the intended expectation associated with the breathing process arguing that this limits the functionality of the patients considering that it forces a patient’s whole body to be in the cylinder whereas only the head is sticking out of the machine. When using the same approach for premature babies, this becomes a critical challenge taking into account that it becomes somewhat challenging to determine the overall effectiveness of the Iron Lung (Van Reempts et al., 2003). Scholars recognized that the Iron Lung posed more danger than protection for the patients under their care (Barr, 2010).

Van Veenendaal et al. (2009) take note of the fact that usage of the Iron Lung represented a wide array of disadvantages in nursing care taking into account that it created some form of limitations concerning the overall capacity for usage in building on expected outcomes. The time taken in the process of transferring the patient in an out of the Iron Lung machine was somewhat significantly, thus, reducing the time it would take in dealing with any injuries that a patient may encounter (Calvert, 2002). The mechanism was not suitable for babies who were newborn. It was only developed for people suffering from Polio who were unable to breathe correctly and gradually extended to be used in other areas (De Jaegere, Deurloo, et al., 2016). From the Iron Lung, the use of ventilators was implemented.

Mechanical Ventilators and their Advantages 

Colaizy, Younis, Bell, & Klein (2008) identified that the management techniques that were employed were through the use of the endotracheal mechanical ventilation and nasal continuous positive airway pressure (CPAP). The infants required continued support and were continually put at risk of acquiring life-threatening complications including bronchopulmonary dysplasia (BPD) and nosocomial pneumonia (Colaizy et al., 2008). The study provided the functionality of mechanical ventilators and identified the two forms of ventilators which included conventional synchronized intermittent mandatory ventilation (SIMV) and High-frequency Ventilation (HFV). Calvert (2002) reflects on the use of mechanical ventilators arguing that indeed these ventilators played a critical role in ensuring that infants were accorded a safe environment for breathing but resulted in a wide array of complications including issues associated with bronchopulmonary dysplasia (BPD) and nosocomial pneumonia.

With the use of the technologies, there are certain situations which are continually sought to be prevented (Colaizy et al., 2008). The first is the tidal volume (VT), this is the normal volume of air that is displaced when a person is inhaling and exhaling without the use of outside pressure or assistance (Colaizy et al., 2008). There is a specific number of tidal volume that is measured to ensure proper and normal breathing is a person (Colaizy et al., 2008). The ventilators also measure dead space where the volume of gas that is breathed again as the result of the use of the ventilator (Colaizy et al., 2008).

Intermittent Mandatory Ventilation 

Moraes et al. (2009) compared different types of CMVs that have been advanced over the years. The IMV as stated in the study is one of the earliest ventilators that were developed to assist premature babies who were having respiratory problems. This technology was first recorded in 1955 where the intermittent mandatory ventilation (IMV) was established. The IMV was a technology which is defined as very easy to use. The operator could adjust the ventilator parameters. The technology also cost less than more modern ventilators that were in distribution at the time. However, the IMV did not have a mechanism where it would be able to interact with the patient. Hence spontaneous breathing continuously clashed with the mechanical respiration cycles (Moraes et al., 2009).

Due to this, there was an increased length of hospital stay attributed to the more extended periods of mechanical ventilation. There was also additional pulmonary distention that occurred, increased frequency of barotrauma, reduced cardiac output and oxygenation and a recorded increase in the respiratory work prompting a greater need for sedatives (Claure & Bancalari, 2007). As a response to this, Lewis & Owen (2001) argue the fact that it became essential for health professionals to find new alternatives associated with the idea of using mechanical ventilators attributed to the difficulties arising from the same. The respirators used automatic cycles that were initially time-controlled, however, with advancements, they became respiratory triggered and thus allowed the children to adapt better to the ventilator (Lewis & Owen, 2001).

Synchronized Intermittent Mandatory Ventilation (SIMV) 

According to Imanaka, Nishimura, Miyano, Uemura, & Yagihara (2001) synced intermittent mandatory ventilation (SIMV) is considered an enhancement of intermittent mechanical ventilation. The mechanism is an advancement of the ventilator technology that has allowed mechanical breaths to be synchronized with the onset of spontaneous inspiration (Claure & Bancalari, 2007). This synchronization is achieved through the use of signals derived from the spontaneous respiratory activity. The sync was also extended to termination of the positive pressure breath that is linked to the end of the spontaneous inspiration. This device allows the operator to set the number of mechanical breaths per minute. However, there is an interval between the mechanical breaths that provides accommodation for synchronization (Claure & Bancalari, 2007).

The caregiver can adjust the SIMV rate and control the contribution of the ventilator to total ventilation. Moreover, even with the rate set by the operator, each of the mechanical breaths is still synchronized with the inspiratory effort derived (Claure & Bancalari, 2007). Where there is the use of SIMV, in most cases, there is also the use of Pressure support ventilation (PSV) (Imanaka et al., 2001). It is defined as a mode where flow cycling is used to assist with every spontaneous respiratory effort and terminates the mechanical breath as the spontaneous inspiration ends or as soon as inflation is complete (Imanaka et al., 2001). This combination of SIMV and PSV provides a constant background ventilation level and preserve lung recruitment (Imanaka et al., 2001).

The SIMV is also used as a weaning tool in babes that have been born prematurely. Weaning off the baby involves the constant reduction of mandatory breaths that are taken up and an increase in the proportion of the ventilation requirement that is assumed by the baby (Imanaka et al., 2001). Due to this, it can be applied to children and adults as well through the continuous flow, time and patient-cycled, pressure limited ventilation that is to be applied (Imanaka et al., 2001). The technology is used to assist in the improvement of the breathing patterns and oxygenation (Imanaka et al., 2001). The synchronized nature of SIMV also allowed for the problems that were previously experienced with IMV to be eradicated (Imanaka et al., 2001). The breathing system had a demand valve which allows gas to flow in response to the patient’s respiratory effort and where the child is having difficulty in breathing, there are the underlying mandatory cycles set which are produced by the ventilator (Imanaka et al., 2001). However, the mode cannot adjust to auto-cycling, and there is an increase in the work that is required for the respiratory musculature of the infant (Imanaka et al., 2001).

Subsequent advancements and combinations have been presented with the system being combined with a new ventilator mode known as pressure support (PS) (Moraes et al., 2009). The mode was combined with SIMV to maintain and support the efforts that are made by the patient to inhale or exhale. The mode is a form of low cycled assisted ventilation which is designed to maintain the constant and predetermined positive airway pressure which is produced during spontaneous respiration as stated by Moraes et al. (2009). The overall outcome of this is that premature infants’ breathing process is supported in a much safer platform taking into account that this particular advancement seeks to build on a proactive avenue from which to determine the generalized outcomes (Moraes et al., 2009).

Synchronized intermittent Positive Pressure Ventilation (SIPPV) 

SIPPV is a form of non-invasive ventilation which is used to avoid the need to use endotracheal intubation in preterm infants who are having a respiratory failure (Claure & Bancalari, 2007). It is also known as Patient Triggered ventilation (PTV) or Assist/Control Ventilation (A/C) (Claure & Bancalari, 2007). According to Claure & Bancalari (2007), SIPPV is a mode of ventilation where a mechanical breath continually assists every spontaneous inspiratory effort. There is an intermittent mandatory ventilator which can provide backup ventilation where there is no spontaneous breathing effort or where the inspiratory effort is considered insufficient to trigger a mechanical attempt (Claure & Bancalari, 2007). The device can provide continuous assistance with every respiratory attempt to prevent exhaustion and fatigue and thus yielding a better tidal Volume to dead space ration than unassisted spontaneous breaths (Claure & Bancalari, 2007).

The use of SIPPV has been attributed to the effective decrease in the number of preterm infants being re-intubated as compared to the nasal CPAP (Colaizy et al., 2008). It is used more than Synchronized intermittent mandatory ventilation (SIMV) (Colaizy et al., 2008). It is considered as a better alternative for continued endotracheal mechanical ventilation after surfactant therapy for gestation infants with respiratory distress syndrome (Colaizy et al., 2008). The use of this device has consequently led to the decrease in the need for supplemental oxygen during hospitalization and had a shorter hospital stay for such infants compared to other infants who remained on the nasal CPAP ventilator (Colaizy et al., 2008).

Jeng et al., 2012, in their research on the neonatal air leak syndromes and the role of HFV in its prevention, identified that the syndromes included pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, subcutaneous emphysema and systemic air embolism. They also reported that these syndromes were extensive as a result of inadequate mechanical ventilation. They recommended that there is a need to prevent air leak syndrome which is ultimately achieved by use of low tidal volume, gentle ventilation with low pressure, low inspiratory time, high rate, and judicious use of positive end-expiratory pressure for infants and preterm babies (Jeng et al., 2012).

High-Frequency Ventilation (HFV) and Its Advantages 

Duval et al. (2009) mention that HFV was introduced in the early 1970s when Oberg and Sjóstrand were experimenting with various technologies. In their experiments, they used higher frequencies and maintained the tidal volumes at meager rates to eliminate the effects of respiratory variations on carotid sinus reflexes. According to Jeng et al. (2012), High-Frequency Ventilation (HFV) is a technology, which uses respiratory rates that significantly exceed the rate of normal breathing. It has been reported that there is an inverse relationship between the birth weight and incidence of air leaks. Where the babies experience meager birth weight, and in meconium-aspirated infants, there is a higher chance of occurrence of air leaks in the infants. Lampland & Mammel (2007) argue that HFV is a technology that uses small tidal volumes which has exceptionally rapid ventilator rates, which uses strict intrathoracic pressure variations and can disengage ventilation from oxygenation.

According to Lewis & Owen (2001), the previously used technologies have employed the use of the conventional bulk flow of gas. This means that where there is the use of CMV or spontaneous respiration, the gas exchange that occurs because there is a convective flow of both oxygen and carbon dioxide molecules from the conducting airways through to the peripheral airways. In this instance, the amount or volume of gas that is being inhaled should exceed that within the dead space volume. However, the ventilation is unable to generate the various tidal volumes that are to exceed the quantities of gases in the dead space. HFV utilizes different gas transport mechanisms to ensure that it can provide adequate ventilation and generate smaller tidal amounts than that within the dead space.

Hoehn, Busch, & Krause (2000) maintain that several gas transport mechanisms are utilized in HFV which include direct ventilation, turbulent flow, pendelluft flow, cardiogenic mixing, and the asymmetric velocity profiles. Another method is through the laminar flow with lateral transport by diffusion and lastly through collateral ventilation through non-airway connections between neighboring alveoli. The direct ventilation and turbulent flow focus on assisting the premature infants to enhance their respiratory systems to overcome other significant conditions that may result from poor breathing system. The pendelluft flow occurs between the adjacent areas of lung with varying time constants for alveolar emptying. The cardiogenic mixing occurs due to the distortion of lung units adjacent to the contracting heart. The mentioned transport mechanism helps in studying children with high oscillatory ventilation.

According to Simma, Gülberg, Schobel, Trawöger, Ulmer, Gerbes, & Putz (2000), the use of the tidal rate volumes, the technology has been divided into three categories: High Frequency Positive Pressure Ventilation (HPPV) where the rate is 60-150/minute, the High-Frequency Jet Ventilation (HFJV) with its rate at 100-600/minute, and the High-Frequency Oscillatory Ventilation (HFOV) with its rate as 300-3000/minute. The use of oscillatory ventilation compared to other conventional positive pressure or jet ventilation as it can promote gas exchange while using tidal volumes that are less than dead space. HFV can hold very low tidal volumes and supra-physiologic rates that have shown and proven to be successful in reducing the lung injury in premature babies. One of the basic concepts that are employed in the operation of HFV is that of adequate gas exchange concerning the tidal volumes the gas exchange tidal volume should be able to exceed the volume of the conducting airways (Dead space), only HFOV has been evidenced to achieve adequate ventilation.

High-Frequency Oscillatory Ventilation (HVOF) 

According to Calvert (2002), HFOV has been credited to be more successful as it utilizes tidal volumes to promote gas exchange compared with the three technologies. Van Reempts et al. (2003) mention that the HFOV is a technology that was discovered by Bohn et al. and Butler et al. in 1980 as they were trying to demonstrate that adequate gas exchange was possible through the generation of oscillation in the airways at a frequency of 15Hz. The oscillations were generated using loudspeakers or with an electronically driven piston pump. According to Miedema et al. (2012), previous researches indicate that adequate ventilation in dogs was achieved using frequencies ranging from 20 to 40Hz. This was an indicator that the use of the adequate ventilation with lower rates among the premature babies would play an essential role in assisting their respiratory system and allow effective breathing.

According to Duval et al. (2009), the decrease in frequency translates to the increase in the delivered tidal volumes. This is because there are longer respiratory cycles which allow a more massive swing of the oscillating membrane. As a result, the system can pull out more carbon dioxide at lower frequencies. There is both an ongoing inspiration and expiration process during respiration. The system requires an electromagnetically driven diaphragm or a piston pump to generate the necessary oscillating movements of the diaphragm and induce the current inspirations and expirations. Jeng et al. (2012) indicate that the use of HFOV has been spread across during the process of caring for the babies that have been prematurely born considering that the ventilator is mostly used as the first line ventilator as it prevents most of the respiratory diseases.

According to van Veenendaal et al. (2009), various studies ascertain the advantage of using the HFOV for the premature birth and assist in respiratory breathing. This has led to a decrease in the risks that have been associated with the use of other types of conventional mechanical ventilation. Lewis & Owen (2001) maintain that there is a reduced risk of air leak syndrome, which is attributed to the ability of the technology to generate gas exchanges with extremely low frequencies and tidal volumes in the dead spaces while at the same time extracting carbon dioxide from the lungs at high rates. The technological advancements have reduced chances and reports of air leaks in patients that have been placed under HFOV systems thus playing a critical role in assisting the patients with breathing difficulties. Simma et al. (2000) mention that HFOV systems can reduce VILI compared with CMV.

According to Simma et al. (2000), the use of HFOV in premature babies has yielded few determined results but has surpassed advantages presented by the use of conventional mechanical ventilation in assisting premature babies. In various tests carried out since its development, the system has been attributed to the decrease in extubating failures. Additionally, there is a decrease in the number of respiratory diseases and complications arising from the use of CMV. Aktas et al. (2016) tested the feasibility of nasal HFOV systems after extubating in challenging to wean premature babies that were previously on CMVs who had a high risk of extubation failure. The experiment was successful, and they were able to try to wean premature infants from mechanical ventilation Aktas et al. (2016). Similarly, in some other nursing care facilities across different European countries, the study identified the use of HFOV systems in cases where the nasal CPAP had failed to develop nasal prongs. The study recommended the use of HFOV I early times of respiratory failure and when one needs to facilitate the extubation in patients who exhibit prolonged intubation.

Discussion and Conclusion 

The use of Conventional Mechanical ventilation has been attributed to many advantages regarding the aspect of assisting premature infants regarding their respiratory systems. However, the use of HFV systems has been the most successful in the development of the respiratory systems of babies born prematurely. The Conventional Mechanical ventilation systems were used to foster better healthcare for the children during a period with no technological advancements that assisted the premature infants (Cools, Askie, & Offringa, 2009). The first advantage associated with the use of HFOV system entails the ability to reduce the number of VILI that is present in the preterm babies. There is a consistency with the use of HFOV in ventilating patients with an adequate amount of lung volume and minimize the risks of contracting volutrauma and atelectrauma. The second advantage entails success in the management of ventilation support for preterm infants (Lampland & Mammel, 2007).

According to Jeng et al. (2012), HFOV is being used as a rescue therapy where it can assist in the treatment of failures because of the use of CMVs and other ventilation systems. HFOV was very successful in reducing the amount or rate of pulmonary leaks as seen in premature infants treated with HFOV rather than CMV. Duval et al. 2009 argue that even with this advantage, there was still no significant difference in the rate of gross pulmonary air leak when using HFOV and CMV. Very few studies seek to prove or support the routine use of HFOV over CMV in the management of air leaks that are present in premature infants who suffer from pulmonary dysfunction. Similarly, the system is used in children who have small airway disease (SAD), and DAD, in patients who exhibit oxygenation disturbances and a chest x-ray with bilateral; opacities (ARDS, lung contusion, pneumonia)

According to De Jaegere, Deurloo et al. (2016), there are long-term benefits associated with the use of HFOV considering that babies that were born preterm and were placed under HFOV care developed higher academic achievement levels in three of eight school subjects than other children. Similarly, these children exhibited better lung function capabilities as adolescents compared to other children that were previously placed under CMV care. These children were able to breathe out better than those that were under the CMV care. There was an observance of better cognitive skills in the group placed under HFOV suggesting that they had developed better visual and spatial abilities. Although the use was of HFOV was associated with long-term benefits. There was caution on the continued use of the system among the premature babies to avoid adverse effects.

The use of HFOV has continually been associated with increased intraventricular hemorrhage among the premature infants (Bollen, Uiterwaal, & van Vught, 2007). However, there is little evidence to support this argument, and thus this is based on speculations from different cases. In another instance, when it is used as a high airway pressure, physicians are cautioned as it can result in an impaired cardiac output that ultimately causes hypotension (Bollen, Uiterwaal, & van Vught, 2007). The presence of this complication leads to the need to develop inotropic support or volume expansion to rectify the situation. In such scenarios, most infants do not respond as required when trying to remedy the situation. In other cases, there have been reports of infants poorly returning to HFOV and thus requiring that they are reverted to conventional mechanical ventilation that poses more danger to their respiratory breathing.

Recommendations 

When dealing with the use of HFOV in premature infants, it is necessary to capitalize on various proposals that help in enhancing the efficiency when dealing with premature babies to avoid any form of complications. The first recommendation entails the use of positive pressure technologies other than the use of use of the Iron Lung and use of negative pressure. The positive pressure technology provides a better advantage for nursing care based on the continued advancements in the technological world affecting the processes within the medical industries. The second recommendation involves the constant use of HFVs other than the CMVs to capitalize on the management and control of respiratory breathing among the children that are born prematurely. The continued use of HFOV has portrayed a continuous improvement in the survival rate of children who are born prematurely since the 1900s. It is necessary to focus on minimizing the risks of lung injury in using these technologies to guarantee the survival of such babies.

References

Aktas, S., Unal, S., Aksu, M., Ozcan, E., Ergenekon, E., Turkyilmaz, C., ... & Atalay, Y. (2015). Nasal HFOV with binasal cannula appears effective and feasible in ELBW newborns.  Journal of tropical pediatrics ,  62 (2), 165-168.

Barr, M. (2010). The iron lung–a polio patient's story.  Journal of the Royal Society of Medicine ,  103 (6), 256-259.

Bollen, C. W., Uiterwaal, C. S., & van Vught, A. J. (2007). Meta-regression analysis of high-frequency ventilation vs. conventional ventilation in infant respiratory distress syndrome. Intensive care medicine ,  33 (4), 680-688.

Calvert, S. (2002). Prophylactic high‐frequency oscillatory ventilation in preterm infants.  Acta Paediatrica ,  91 (s437), 16-18.

Claure, N., & Bancalari, E. (2007). New modes of mechanical ventilation in the preterm newborn: evidence of benefit.  Archives of Disease in Childhood-Fetal and Neonatal Edition ,  92 (6), F508-F512.

Colaizy, T. T., Younis, U. M., Bell, E. F., & Klein, J. M. (2008). Nasal high ‐ frequency ventilation for premature infants.  Acta paediatrica ,  97 (11), 1518-1522.

Cools, F., Askie, L. M., & Offringa, M. (2009). Elective high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome: an individual patient data meta-analysis.  BMC Pediatrics ,  9 (1), 33-46.

De Jaeger, A. P., Deurloo, E. E., van Rijn, R. R., Offringa, M., & van Kaam, A. H. (2016). Individualized lung recruitment during high-frequency ventilation in preterm infants is not associated with lung hyperinflation and air leaks.  European journal of Pediatrics ,  175 (8), 1085-1090.

Duval, E. I., Markhorst, D. G., & van Vught, A. J. (2009). High-frequency oscillatory ventilation in children: an overview. Respiratory Medicine CME ,  2 (4), 155-161.

Hoehn, T., Busch, A., & Krause, M. F. (2000). Comparison of noise levels caused by four different neonatal high-frequency ventilators.  Intensive care medicine ,  26 (1), 84-87.

Imanaka, H., Nishimura, M., Miyano, H., Uemura, H., & Yagihara, T. (2001). Effect of synchronized intermittent mandatory ventilation on respiratory workload in infants after cardiac surgery.  Anesthesiology: The Journal of the American Society of Anesthesiologists ,  95 (4), 881-888.

Jeng, M. J., Lee, Y. S., Tsao, P. C., & Soong, W. J. (2012). Neonatal air leak syndrome and the role of high-frequency ventilation in its prevention.  Journal of the Chinese Medical Association ,  75 (11), 551-559.

Lampland, A. L., & Mammel, M. C. (2007). The role of high-frequency ventilation in neonates: evidence-based recommendations.  Clinics in Perinatology ,  34 (1), 129-144.

Lemos, M., & Gomes, M. R. (2017). Exchanges between Literature and Science from the 1800s to the 2000s: Converging Realms . New York, NY: Cambridge Scholars Publishing. 

Lewis, M. A., & Owen, M. R. (2001). The mechanics of lung tissue under high-frequency ventilation.  SIAM Journal on Applied Mathematics ,  61 (5), 1731-1761.

Lu, Y. H., Wang, N., & Jin, F. (2013). Long-term follow-up of children conceived through assisted reproductive technology.  Journal of Zhejiang University Science B ,  14 (5), 359-371.

Miedema, M., de Jongh, F. H., Frerichs, I., van Veenendaal, M. B., & van Kaam, A. H. (2012). Regional respiratory time constants during lung recruitment in high-frequency oscillatory ventilated preterm infants.  Intensive care medicine ,  38 (2), 294-299.

Moraes, M. A. D., Bonatto, R. C., Carpi, M. F., Ricchetti, S. M., Padovani, C. R., & Fioretto, J. R. (2009). Comparison between intermittent mandatory ventilation and synchronized intermittent necessary ventilation with pressure support in children. Jornal de pediatria ,  85 (1), 15-20.

Simma, B., Gülberg, V., Schobel, P., Trawöger, R., Ulmer, H., Gerbes, A. L., & Putz, G. (2000). High-frequency oscillatory ventilation does not decrease endothelin release in lung-lavaged rabbits.  Scandinavian journal of clinical and laboratory investigation ,  60 (3), 213-220.

Van Reempts, P., Borstlap, C., Laroche, S., & Van der Auwera, J. C. (2003). Early use of high-frequency ventilation in the premature neonate. European journal of Pediatrics ,  162 (4), 219-226.

Van Veenendaal, M. B., Miedema, M., de Jongh, F. H., van der Lee, J. H., Frerichs, I., & van Kaam, A. H. (2009). Effect of closed endotracheal suction in high-frequency ventilated premature infants measured with electrical impedance tomography.  Intensive care medicine ,  35 (12), 2130.